Provider Demographics
NPI:1134403637
Name:MATZEN, ABBEY G (NP)
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:G
Last Name:MATZEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 JOHN DEERE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6869
Mailing Address - Country:US
Mailing Address - Phone:309-779-4400
Mailing Address - Fax:309-779-4420
Practice Address - Street 1:600 JOHN DEERE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6869
Practice Address - Country:US
Practice Address - Phone:309-779-4400
Practice Address - Fax:309-779-4420
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAA114523363L00000X
IL209.009159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner